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World J Gastroenterol. Nov 28, 2006; 12(44): 7179-7182
Published online Nov 28, 2006. doi: 10.3748/wjg.v12.i44.7179
Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention
Huseyin Bakkaloglu, Hakan Yanar, Recep Guloglu, Korhan Taviloglu, Fatih Tunca, Murat Aksoy, Cemalettin Ertekin, Arzu Poyanli
Huseyin Bakkaloglu, Hakan Yanar, Recep Guloglu, Korhan Taviloglu, Fatih Tunca, Murat Aksoy, Cemalettin Ertekin, Istanbul University, Istanbul Faculty of Medicine, Trauma and Emergency Surgery Service, Capa-Istanbul, Turkey
Arzu Poyanli, Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Capa-Istanbul, Turkey
Correspondence to: Huseyin Bakkaloglu, MD, Istanbul University, Istanbul Faculty of Medicine, Trauma and Emergency Surgery Service, Capa-Istanbul 34390, Turkey. drhuseyin@yahoo.com
Telephone: +90-212-4142000-32418 Fax: +90-212-5331882
Received: June 23, 2006
Revised: June 28, 2006
Accepted: July 18, 2006
Published online: November 28, 2006
Abstract

AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia.

METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases.

RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 × 103± 1.3 × 103μg/L vs 13 × 103± 1 × 103μg/L, P < 0.05 for 24 h after PC; 13.7 × 103± 1.3 × 103μg/L vs 8.3 × 103± 1.2 × 103μg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2 ± 18.5 mg/L vs 27.3 ± 10.4 mg/L, P < 0.05 for 24 h after PC; 51.2 ± 18.5 mg/L vs 5.4 ± 1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38 ± 0.35°C vs 37.3 ± 0.32°C, P < 0.05 for 24 h after PC; 38 ± 0.35°C vs 36.9 ± 0.15°C, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter.

CONCLUSION: As an alternative to surgery, percutan-eous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed cholecystectomy and ERCP, if needed, can be performed after the acute period has been resolved by percutaneous cholecystostomy.

Keywords: Percutaneous cholecystostomy; Acute cholecystitis; Ultrasound; High risk; Elderly